Role of Intermittent Self Dilatation in the Prevention of Urethral Stricture Recurrence after Direct Visual Internal Urethrotomy: a Randomized Controlled Trial

INTRODUCTION Urethral stricture refers to anterior urethral disease, a scarring process involving the spongy erectile tissue of the corpus spongiosum, also referred to as spongiofibrosis 1 . 80% of strictures that are secondary to instrumentation occur at the membranous urethra. The other 20% generally occur at the penoscrotal junction. A study done by Palminteri et al 2 on 1439 patients with urethral stricture showed that 675 patients (46.9%) had stricture in the bulbar urethra and very few had penile plus bulbar urethral stricture. Before the 21 st century, the majority of urethral strictures resulted from urethritis or sexually transmitted diseases. Post inflammatory strictures are seldom seen in todays developed world. Instead, urethral strictures may be from: prostatectomy, perineal trauma, urethral catheterization, idiopathic/unknown, TUR, hypospadias, pelvic fracture, urethritis, cystoscopy and lichen sclerosis 3 . Kashefi et al 4 demonstrated that an estimated 3.2 urethral injures per 1000 inpatients were secondary to traumatic catheterizations. Stein et al 5 in retrospective study involving 2589 patients showed that the most common cause for stricture was idiopathic at 41.3% followed by iatrogenic at 35%. In the other study done by Stein et al 5 in India the most common cause was traumatic at 36%. In patients younger than age 45, hypospadias surgery, idiopathic, lichen sclerosis and pelvic fracture are among the most common causes of urethral strictures. 3